Clinicians in the C-Suite
Leveraging physicians and nurses who care as much about the healthcare business as they do patients.
This article first appeared in the May 2017 issue of HealthLeaders magazine.
Healthcare leadership is evolving in a way that must merge the silos of clinical care and administration, resulting in a growing minority of C-suite positions occupied by physicians and nurses. There are numerous industry drivers of the clinician leadership trend, not the least of which includes mounting industry emphasis on value and quality. And amid various financial pressures and a need for clinicians to help facilitate change, it behooves organizations to close the gap between providers of care and executive leadership.
For some institutions, clinician executives are anything but novel. The Mayo Clinic, for example, boasts a 108-year tradition of physician leadership.
“I’m pleased to see the idea expanding,” says John Noseworthy, MD, president and CEO since 2009 of the Mayo Clinic in Rochester, Minnesota. “I suspect it means that these organizations are trying to find a way to provide more focus on the patients while keeping the tension between business and patients in balance,” he adds, noting that the Mayo model is one of dyad leadership, in which virtually every physician leader is paired with a nonclinical administrative partner.
A scientist at heart, Noseworthy aims to study any topic until he can communicate easily with the “true experts” on that topic, he says. “Once I do that, look out. I’m then the biggest champion of an empowered team, and I let that team run as fast and hard as it can go. Once the Mayo staff owns a solution, we are unstoppable,” he says.
Noseworthy came into his own leadership role by way of altering his original plans to become a neuroscientist and becoming a clinician-investigator instead. “This was plan B, and it not only suited me much better than plan A, but it helped me discover my gift for leadership, which is bringing really smart people together to accomplish what one could not do alone,” he says.
Link to quality
Many hospitals, as ranked annually by U.S. News & World Report (USNWR), are led by physicians. The publication’s 2016–17 Honor Roll was no exception, with physicians at the helm of the top five–ranking hospitals in the following order: Mayo Clinic, Cleveland Clinic, Massachusetts General Hospital, Johns Hopkins Hospital, and UCLA Medical Center.
What’s more, a 2011 study in Social Science & Medicine shows that hospital quality scores—now increasingly tied to reimbursement—are approximately 25% higher in physician-run hospitals than in manager-run hospitals.
In each of three specialty cases studied (cancer, digestive disorders, and heart and heart surgery), the mean Index of Hospital Quality score of hospitals where the CEO is a physician is greater than the mean score of the hospitals where the CEO is a professional manager. For example, the mean IHQ hospital-quality score of the cancer hospitals led by physicians is 31.63, while the mean quality score of cancer hospitals led by nonphysician managers is 23.61; for cancer, the mean of IHQ scores in the sample is 28.0.
Whether physician leadership boosts hospital performance or physician leaders are drawn to high-performing hospitals seems a circular argument, but the former explanation is plausible, says Noseworthy. “It wouldn’t surprise me at all if it’s true because of the way physicians are focused on service to the patient from the beginning of medical school. That’s not to say that administrators aren’t patient-focused, but that concern for patients is often why people become physicians and nurses.”
The paper’s authors also reached ambivalent conclusions. “The findings do not prove that doctors make more effective leaders than professional managers. Potentially, they may even reveal a form of the reverse—assortative matching—in that the top hospitals may be more likely to seek out MDs as leaders and vice versa,” writes Amanda H. Goodall, PhD. “Arguably, however, the better hospitals will have a wider pool of CEO candidates from which to choose, because of the extra status and wealth that they attract. This makes the fact established in this paper an interesting one. The study results show that hospitals positioned highest in the USNWR ranking have made judgments that differ from those hospitals lower down: On average they have chosen to hire physician-leaders as CEOs.”